Every 40 seconds, someone in the United States suffers a heart attack. Now, a Yale study has uncovered racial disparities that may place the lives of elderly Black Americans who experience one at greater risk than those of their white counterparts.
Patrick Demkowicz, a third-year medical student who was lead author on the study, examined disparities in mortality in adults over 75 who had been hospitalized for heart attacks, considering functional impairments in areas such as cognition, mobility, vision, hearing, and muscle strength. The study found that Black patients presented with more impairments at the time of hospitalization, even though their average age was younger than that of white patients. Black patients also had a mortality rate nearly double the rate of white patients. The team published its findings in the Journal of the American Geriatrics Society on November 23.
“There hasn’t been a lot of work focusing on racial disparities specifically in older adults after a heart attack,” says Demkowicz. “This study fulfills that gap in the literature.”
The team utilized data from the multicenter observational SILVER-AMI study, which enrolled 3,041 patients 75 years or older across 94 hospitals who were hospitalized due to a heart attack between 2013 and 2016. Sarwat Chaudhry, MD, professor of medicine (general medicine) was the principal investigator in both SILVER-AMI and the present study.
Functional Impairments May Drive Racial Disparities
Previous research has shown that functional impairments are powerful predictors of survival after a heart attack. So, the team began by comparing rates of functional impairments among Black and white participants. “As we get older, our numerical age doesn’t necessarily correspond to wellness,” says Demkowicz. “Some people are 70, but active and mobile. And there are 50-year-olds who may be doing poorly healthwise. Functional impairments capture this aspect of aging.”
The study found that on average, Black participants tended to be younger than white participants, but they also had higher rates of impairment in mobility, vision, and cognition. They also were more likely to have a disability in one or more activities of daily living, such as bathing, eating, and getting dressed. Furthermore, they were more likely to have had unintentional weight loss greater than 10 pounds in the year prior.
Next, the team looked at rates of mortality six months after hospital discharge. Black participants showed a 16.8 % mortality rate. In comparison, the mortality rate of white participants was 9.3 %. After the researchers adjusted their model to include functional impairments, the disparity between Black and white participants was not statistically significant. “This implies that these functional impairments may be important drivers of racial disparity in mortality,” says Demkowicz.
Despite higher rates of functional impairment, prior research has highlighted disparities in access to services—such as home health care—post-hospitalization, which has been shown to affect mortality in older patients. “By pointing out these disparities, my hope is that our work will encourage doctors to continue routinely assessing for functional impairments and geriatric conditions in older patients, and also for health systems to direct more resources for ensuring access to home health care services for all patients who have these,” Demkowicz says.